What is Ultrasound Guided Sclerotherapy (UGS)?
This is a new technique in which ultrasound is used to guide injections into the veins to block those veins (sclerotherapy). Conventional sclerotherapy has been used for years for small and surface veins, however, not for large veins because they were difficult to locate and there was some concern that the sclerosant injected would go into the deep veins.

How is it Performed?
The current technique involves a dedicated sclerotherapy session. The procedure takes 30–60 minutes. Ultrasound will be used to localize the vein and an injection placed into the vein lower in the leg. The material injected sclerosant will destroy the lining of the vein and ultrasound is used to localize the injection and to watch this material travel up the vein and when it reaches the top of the vein to compress the vein and minimise the amount of sclerosant travelling into the deep vein. A compressive bandage very similar to that used for vein surgery is applied and the patient is then asked to get up and walk around for 15 minutes. This muscle activity will wash out the deep veins while retaining sclerosant in the superficial veins. The compressive bandage (stockings may be used) will compress the superficial vein to minimise the amount of clot which will form in the vein as part of the vein destruction process.

Post Injection Care
The patient will then go home and wear the bandage for one week or go straight into stockings –as per doctors instructions. After review, this will be replaced by support stockings for 3 to 4 weeks. Follow-up sclerotherapy (1-4 sessions) is commenced after 6-8 weeks.

What is Injected?
We are currently injecting Fibrovein or Polidocanol. Both of these have a long history of being used for surface veins and are very safe and effective. Both can cause allergic reactions locally or generally (asthma, rash).

Mobility
By avoiding anaesthesia and time in hospital, the risk of deep venous thrombosis is minimised. It is not zero because this is still a procedure and a small amount of sclerosant inevitably leaks into the deep system even in this technique.

Common Complications
The destroyed vein may fill up with blood and this can cause lumps under the skin with some associated redness. It is possible to remove this blood. This reaction is called phlebitis and is the basis of the procedure. Injection and immediate leg compression aim to minimise the amount of phlebitis. Most patients have a small amount. Please call the rooms if this develops for an early review appointment. The phlebitis will settle and does not necessarily imply that the end result will be a poor outcome. This technique is used as an alternative to surgery and for those patients who wish to avoid surgery, anaesthesia, hospital etc. It doesn’t deal with the small veins (nor does surgery). Follow up sclerotherapy is often required. If the vein is not completely blocked with ultrasound guided sclerotherapy, a second or third treatment is included if needed.

What are the Alternative Procedures Available?
Surgery has an advantage to country patients who wish to avoid multiple visits. It is suitable for men with large varicose veins who won’t require follow-up conventional sclerotherapy. Our clinic has expertise in surgery, ultrasound-guided sclerotherapy, conventional sclerotherapy and new methods for treating veins such as Endovenous Laster Therapy (EVLT). We aim to discuss them all with you.

What is the Cost?
The standard sclerotherapy rebate (Item 32500) of about $80.00 applies for up to six sessions of sclerotherapy for veins over 4mm per year. Private health insurance does not contribute extra because this is an outpatient procedure. We will provide a preoperative cost estimate and discuss the likely number of sessions before commencing treatment. The same item number applies to each session of any type of sclerotherapy.

Do I have to Have Conventional Sclerotherapy?
No.

When Shouuld I Avoic Sclerotherapy?
We advise against sclerotherapy if you have a current medical illness, are pregnant, take Warfarin, plan to travel overseas or interstate within 6 weeks. You will need a person to drive you home from the session. Most of these issues can be worked out with adequate prior planning.

If you are concerned about visible varicose veins you will probably require ultrasound-guided sclerotherapy and then conventional sclerotherapy. If you have large veins which are causing skin changes and ulceration in you legs then dealing with the large veins is the medically necessary part of the procedure and dealing with the surface veins is optional.

Further Questions?
Please do not hesitate to call our rooms if you have any further question regarding logistics and costs or any medical questions.

What to Expect

1. The patient will need to attend an initial consultation. If you are new to the practice we may be able to arrange an ultrasound examination before that consultation by calling our rooms. If you prefer you can see Mr Self first and then we can arrange an ultrasound and review.
2. If you are a suitable candidate for ultrasound guided sclerotherapy we will need to organise this as a separate consultation.
3. On the day of your procedure, we recommend taking an afternoon off work. You can return to work the following day. If your work is physical and involves a lot of bending at the knees, please discuss this in advance. If you have children, we recommend you organise care for them or bring a friend/relative to mind them as it will not be possible to leave them along during your procedure.
4. If you were previously wearing support stockings, please bring them with you for review.
   
   
5. You need to bring a driver for each session and wear some loose comfortable clothing as your leg may be bandaged from the toes to the upper thigh. This bandage will probably stay on for 4 or 5 days and then be replaced by a full leg support stocking to be worn during the day. Some patients may avoid bandaging but it is important not to assume that. Bandages cannot be removed so have a good shower and wash your hair!
6. The procedure is done in the Ultrasound Clinic and takes 30 to 60 minutes.
7. No sedation is used.
8. On occasions, local anaesthetic is used but usually the injections are with a very fine needle and there aren’t many of them.
9. The technique involves a quick review ultrasound then laying on a table, which tilts. This will allow for injections whilst you are tilted, i.e. somewhat like standing. The Ultrasonographer will provide ultrasound during this. At the end of the procedure dressings or stockings will be applied to the leg.
10. You will need to have a long loose skirt or a pair of tracksuit pants and some runners or very loose sandals.
11. We recommend walking up and down the consulting waiting area several times to wash out any overflow sclerosant from the deeper veins.
12. You will receive an account which we expect to be paid before leaving the rooms. We will organise a review ultrasound which is usually one or two weeks after and a review appointment usually one week later. Simultaneous ultrasound and consultations can be arranged at the Richmond rooms.
13. After you leave the rooms, we recommend the patient takes a short walk to the local shops to have a cup of tea or some lunch before driving home.
14. Total time in the room could be about 2 hours, so please be careful about parking as the parking officers in Richmond are very diligent.
15. At home that evening, we recommend walking.
16. Over the next few days, we recommend walking several times a day for 10 to 15 minutes and to sit with your feet elevated. It is best to avoid prolonged standing.
17. After removal of your bandage, the patient may shower, but please avoid hot baths or long hot showers and swimming for the first few weeks.

GREG SELF
Vascular Surgeon